Candidate checklist
NI Assembly Election
This checklist is designed to assist candidates standing for election to the NI Assembly in preparing
to submit their nomination, and should be read alongside the Guide for Candidates and Agents.
Task
Nomination paper (all candidates)
Add your full name – surname in the first box and all other names in the second.
Optional - Use the commonly used name(s) boxes if you are commonly known by a name
other than your full name and want it to be used instead of your full name.
Description – Party candidates can use a party name or description registered with the
Electoral Commission’s website and supported by authorisation from that party; others
can use ‘Independent’ or leave this blank.
Subscribers – all ten subscribers must sign. Use your copy of the 3 January 2017
electoral register to make sure the electoral numbers are accurate.
Candidate’s home address form (all candidates)
Part 1 must be completed. Insert your full name and home address.
Optional – if you do not want to have your home address printed on the statement of
persons nominated and ballot papers, complete Part 2 of the form, giving the name of the
constituency (or country if outside the UK) that your address is in, and sign the form.
Candidate’s consent to nomination (all candidates)
Add your full name and date of birth.
Tick the relevant declaration (No. 1 or No. 2)
Sign and date the document in the presence of a witness.
The witness must complete and sign the witness section.
Deposit (all candidates)
£150 to be deposited with the Deputy Returning Officer.
Ensure you have completed Form 1e (Name and address for return of deposit) and
included your email address.
Request for party description/emblem
Add your full name.
Ensure the party Nominating Officer has completed the schedule authorising use of the
description and emblem and lodged it with the Returning Officer by 1pm on 8 February.
Ensure you have indicated the emblem you wish to use by giving the description and
number from the Electoral Commission website.
Appoint an election agent (if not acting as own election agent)
Add your full name.
Give the name, address and office address of the appointed election agent.
Ensure the appointed agent signs and dates the form showing their acceptance.
Request for electoral register/absent voter list
Specify the format (paper/data) required.
Specify whether the absent voter list/overseas elector list is required.
Tick
Office
Use
only
Date received Time received Initials
1a
NI Assembly Election
Election of a member to
serve in the Northern
Ireland Assembly for the
Nomination paper
Date of
election
Constituency
Thursday
2 March 2017
We, the undersigned, being electors for the said Constituency, do hereby nominate the undermentioned person as a candidate at the said election.
Candidate’s Details
Candidate’s surname
Other names in full
Commonly used surname (if any)
Commonly used forenames (if any)
Description (if any)
Subscribers
Electoral Number
Signatures
Print full name
Ward No.
Electoral
No.
Proposer
Seconder
We, the undersigned, being electors for the said Constituency, do hereby assent to the foregoing
nomination
1
2
3
4
5
6
7
8
This form must be delivered to the Deputy Returning Officer by 1pm on Wednesday 8 February 2017.
NOTES
1.
You are advised to read the relevant sections of the Guide for Candidates and Agents
before completing the forms and to complete all sections in CAPITAL LETTERS except
for signatures and dates.
2.
The attention of candidates and electors is drawn to the rules for completing nomination
papers and other provisions relating to nomination contained in the parliamentary
elections rules in Schedule 1 to the Representation of the People Act 1983 (as modified
for Assembly elections).
3.
Where a candidate is commonly known by some title he or she may be described by his
or her title as if it were his or her surname.
3A. Where a candidate commonly uses a name which is different from any other name he or
she has, the commonly used name may also be provided on the nomination paper, but if
it does so, the commonly used name (instead of any other name) will appear on the
ballot paper.
3B. But the ballot paper will show the other name if the Deputy Returning Officer thinks:
(a) that the use of the commonly used name may be likely to mislead or confuse
electors, or
(b) that the commonly used name is obscene or offensive.
4.
An elector may not subscribe more nomination papers for the constituency than there
are vacancies to be filled (i.e. five).
5.
A person whose name is entered in the register may not subscribe a nomination paper if
the entry gives as the date on which he or she will become of voting age a date later
than the day fixed for the poll.
6.
Where, because of disability or inability to read, a person is unable to sign a nomination
paper, home address form or consent to nomination they may instead make their mark.
The mark must be witnessed by a person who must provide their signature and address
on the back of the form.
7.
This form, along with the home address form and consent to nomination, must be
delivered to the Deputy Returning Officer by 1pm on Wednesday 8 February 2017.
Incomplete, illegible or incorrectly completed forms will be invalid.
Office
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Date received Time received Initials
1b
NI Assembly Election
Home address form
Constituency
Date of election
Thursday
2 March 2017
● You must complete Part 1.
● Only complete Part 2 if you do not wish your home address to be made public.
Part 1: To be completed by all candidates
Candidate’s full name
Home address (in full)
Postcode
If you are only completing Part 1 please deliver this form with the nomination paper and consent to
nomination to the Deputy Returning Officer by 1pm on Wednesday 8 February 2017.
Part 2: To be completed only if you do not wish your home address to be made public
If you request that your home address is not made public then your address will not appear on the
statement of persons nominated or the ballot paper.
If you choose not to make your home address public, the official constituency name (e.g. Belfast
South, East Londonderry) in which your home address is located (or country, if outside the UK) will
appear on the statement of persons nominated and the ballot paper.
Statement: I require my home address not to be made public.
The constituency which my
home address is located in
(insert official name of constituency)
or
My home address is outside
the United Kingdom. My
home address is located in
(insert name of country)
Signature of candidate (only required if Part 2 has been completed).
Candidate’s signature
Date
This form must be delivered to the Deputy Returning Officer by 1pm on Wednesday 8 February 2017.
Office
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Date received Time received Initials
1c
NI Assembly Election
Consent to nomination
Constituency
Date of election
Thursday
2 March 2017
Candidate’s details and declaration
I confirm
that I
(candidate name in full)
hereby consent to my nomination as a candidate for election as member of the Northern Ireland
Assembly for the constituency named above.
I declare that I am aware of the provisions of the Northern Ireland Assembly Disqualification Act
1975 and section 36 of the Northern Ireland Act 1998. I am not standing as a candidate in any
other constituency at this election.
Select one of the declarations below.
(Tick box)
1. I declare that, to the best of my knowledge and belief, I am not disqualified for
membership of the Assembly, or
2. I declare that, to the best of my knowledge and belief, I am disqualified for
membership of the Assembly only under section 1(1)(za) or (db) of the Northern
Ireland Assembly Disqualification Act 1975 (disqualification of MPs or members of
the Dáil Éireann)
My date of birth is
Day (DD)
Month (MM)
Year (YYYY)
Note: it is an offence to make a false declaration. Maximum penalty one year imprisonment.
Candidate’s signature
Date
Witness details
I confirm the candidate named above signed this declaration in my presence.
Witness’ full name
Witness’ address
(in full)
Witness’ signature
Date
This form must be delivered to the Deputy Returning Officer by 1pm on Wednesday 8 February 2017.
Office
Use
only
Date received Time received Initials
1d
NI Assembly Election
Constituency
Withdrawal of candidate
Date of election
Thursday
2 March 2017
Candidate’s details
Candidate’s full name
Candidate’s address
(in full)
Having been nominated as a candidate at the above election I hereby give you notice that I
withdraw my name from candidature at such election.
Candidate’s signature
Date
Witness details
I confirm the candidate named above signed this declaration in my presence.
Witness’ full name
Witness’ address
(in full)
Witness’ signature
Date
This form must be delivered to the Deputy Returning Officer by 1pm on Wednesday 8 February
2017.
Office
Use
only
Date received Time received Initials
1e
NI Assembly Election
Name and address for return of deposit
Constituency
Date of election
Thursday
2 March 2017
Provided the number of votes credited to the candidate at any stage of the count exceeds one
quarter of the quota, a cheque refunding their deposit will be posted to them within one working day
of the result of the election being declared. If the candidate does not receive more than one quarter
of the quota, their deposit will be forfeited.
Candidate’s details
Candidate’s full name
Candidate’s address
(in full)
Candidate’s party name
(if any). If Independent
state ‘Independent’
Candidate’s telephone
number
Candidate’s email
address
Name and address to which deposit should be returned (if different from above)
Name of payee (in
CAPITAL LETTERS)
Address (in full)
Telephone number
Email address
Name and signature of person completing this form
Name of person completing this
form (in CAPITAL LETTERS)
Signature of person completing
this form
Date
Signature of Deputy Returning
Officer
Date
This form must be delivered to the Deputy Returning Officer by 1pm on Wednesday 8 February 2017.
Office
Use
only
Date received Time received Initials
2
NI Assembly Election
Constituency
Request to use party description/emblem
Date of election
Thursday
2 March 2017
Complete this form if you wish to have a party description or party emblem on the ballot paper next
to your name.
Candidate’s name
I wish to use the following description as registered with the Electoral Commission. This
description matches the one authorised by the party nominating officer and that included on the
nomination form.
The emblem must be one of the emblems registered by your political party, or in the case of a joint
candidate one of the parties registered with the Electoral Commission. Where a party has more
than one registered emblem, the one that is authorised for use must be specified by giving the
unique number or description allocated to it on the Electoral Commission website
https://pefonline.electoralcommission.org.uk/search/searchintro.aspx.
I wish to use the party emblem number/description as shown on the Electoral Commission website.
Emblem number/
description
In the case of a joint candidate the schedule must be signed by the Nominating Officers of all
parties, or persons authorised by them.
The Nominating Officer has completed the schedule authorising my use of the above description
on the ballot paper and lodged it with the Returning Officer.
Candidate’s signature
Date
This form must be delivered to the Deputy Returning Officer by 1pm on Wednesday 8 February 2017.
Office
Use
only
Date received Time received Initials
3a
NI Assembly Election
Constituency
Appointment of election agent
Date of election
Thursday
2 March 2017
Candidate’s notification of their election agent
I, (candidate name in full)
hereby declare that the name and address of my election agent is
Agent’s name
Agent’s address
(in full)
The office address of my election agent to which all claims, notices, legal process and other
documents may be sent is (note: the address must be in the constituency or an adjoining
constituency):
Agent’s office address
(in full)
Candidate’s signature (or
signature of person
authorised to act on
behalf of candidate)
Date
Confirmation of acceptance by election agent
I [agent named above] confirm my acceptance as the election agent for the above named
candidate. I understand that I must carry out my duties according to law. I understand that
there are penalties if I fail to fulfil my duties according to law.
Agent’s signature
Date
Agent’s other details in case of query (optional – will not be published)
Home telephone
Work telephone
Mobile telephone
Email address
This form must be delivered to the Deputy Returning Officer by 1pm on Wednesday 8 February
2017.
NI Assembly Election
Date received Time received Initials
Appointment of sub-agents
Constituency
Date of election
Office
Use
only
3b
Thursday 2 March 2017
You may appoint one sub-agent to act for any part of a constituency, but these parts must not overlap. The provision of contact details (apart from
address) is optional but it may take longer for important information to be forwarded to your sub-agents if they are not provided. The office address
must be within the area for which the sub-agent has been appointed. Sub-agents cannot be appointed in the four Belfast constituencies.
Candidate’s name
Election agent’s name
I [agent named above] appoint the following persons to be my sub-agents in the parts of the constituency specified below:
Sub-agent’s name
Sub-agent’s address
(in full)
Office address (if different)
Part of constituency
(parliamentary wards
e.g. 0101, 2651)
Home/mobile
telephone no.
Email address
Election agent’s signature
Continue on a separate sheet if necessary. This form must be delivered to the Deputy Returning Officer by Tuesday 28 February 2017.
Office
Use
only
Date received Time received Initials
3c
NI Assembly Election
Constituency
Appointment of polling agents
Date of election
Thursday
2 March 2017
Polling agents can be appointed by the candidate or their election agent.
Only one polling agent per candidate may be present at any ballot box at any one time.
Polling agents must produce photographic identification of a type that can be used by a voter to gain
access to the polling station.
A separate form must be used for each ballot box. Incomplete, illegible or incorrectly completed forms
will be invalid.
Please return this form plus any additional sheets in ballot box number order within the constituency to
the Deputy Returning Officer by Thursday 23 February 2017. The original form plus ONE COPY
must be returned.
Candidate’s name
Election agent’s name
Candidate or election
agent’s signature
Polling Place
Ballot Box No.
I appoint the following people as polling agents:
Full Name (CAPITAL LETTERS)
in alphabetical order
Full address including post code (CAPITAL LETTERS)
Candidate’s name
Full Name (CAPITAL LETTERS)
in alphabetical order
Ballot Box
No.
Full address including post code (CAPITAL LETTERS)
NI ASSEMBLY ELECTION 2 MARCH 2017
POLLING AGENT INSTRUCTIONS
These notes are provided for your guidance. You are advised to read them carefully.
Contravening them is likely to result in your being excluded from the polling station
and/or reported to the police for investigation and possible prosecution.
A:
Your Role
The only statutory duties of a polling agent are to:
1.
Guard against personation (i.e. elector pretending to be someone else).
2.
Inspect the ballot box to which you have been appointed before the poll opens to ensure it
is empty.
3.
Affix a seal to the ballot box at the close of poll if you wish.
4.
Be present when the presiding officer marks a ballot paper for a voter with disabilities.
B:
You must
1.
Obey the lawful instructions of the presiding officer and their staff.
2.
Report to the presiding officer on every occasion that you enter or leave the polling station
(i.e. the room where the poll is taking place).
3.
Produce photographic identification (of a type used by electors) to the presiding officer or
their staff when first entering the polling station and thereafter on request.
4.
Sit at the table provided except when carrying out your duties (see section A above).
5.
Conduct yourself in an orderly manner.
C:
1.
You must not
Before 10pm pass information on who has voted to anyone inside or outside the polling
station.
2.
Before 10pm remove from the polling station a register or other document showing who
has voted.
3.
Try to persuade any person to vote in a particular way.
4.
Use a mobile phone or other electronic equipment (e.g. iPad) for speech, text,
photographs, video or any other purpose.
5.
Make written notes (other than marking a copy of the electoral register) and take
information out of the polling station.
6.
Speak to the presiding officer or their staff except as required by your duties (see section
A above).
Page 1 of 2
7.
Ask the presiding officer or their staff for confirmation on the number of ballot papers
issued (this will be available on the Notice at the prescribed times).
8.
Speak to any elector except as required by your duties (see section A above).
9.
Enter any polling booth other than to inspect it – you can do this only when the booth is
not in use – or when watching the presiding officer assisting an elector.
10. Place any notice in any polling booth or deface any notice displayed.
11. Give a dummy ballot paper or other document to any elector.
12. Loiter anywhere within the premises used for the polling station – if you are not on duty at
the ballot box to which you have been appointed you must leave the premises
immediately.
13. Consume alcohol on the premises used for the polling station.
14. Smoke tobacco anywhere within the premises used for the polling station or in any
playground or yard attached to the premises.
15. Eat food, other than sweets or similar items, anywhere on the premises used for the
polling station.
16. Do anything which hinders the presiding officer or their staff in the performance of their
duties or otherwise disrupt the smooth running of the polling station.
D:
You may
1.
Wear a party rosette, it should be plain and not refer to a specific candidate or party.
2.
Mark a copy of the electoral register to indicate the electors to whom a ballot paper has
been issued but you must not take the marked copy out of the polling station before 10pm.
3.
Ask the presiding officer or their staff to repeat the name and electoral number of any
elector if you did not hear it.
4.
Ask the presiding officer to ask the statutory questions if you believe that an elector is
attempting personation.
5.
Leave the polling station whenever you wish after first having reported to the presiding
officer or their staff.
6.
Re-enter the polling station provided no other polling agent for the same candidate is
present. You must report to the presiding officer or their staff whenever you re-enter the
polling station.
Page 2 of 2
Office
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Date received Time received Initials
3d
NI Assembly Election
Appointment of counting agents
Constituency
Date of election
Thursday
2 March 2017
Counting agents can be appointed by the candidate or their election agent.
The Deputy Returning Officer will tell you the maximum number of counting agents you can appoint once
the number of candidates is known. Each candidate may nominate one other person to be present.
Counting agents will have to produce photographic identification of a type that can be used by a voter to
gain access to the count venue.
Incomplete, illegible or incorrectly completed forms will be invalid.
Candidate’s name
Election agent’s name
Candidate or election agent’s
signature
Name and address of other
person entitled to be present
I appoint the following people to act as counting agents at the count of votes for the above constituency:
Full name (CAPITAL LETTERS)
Full address including postcode (CAPITAL LETTERS)
This form must be delivered to the Deputy Returning Officer by Thursday 23 February 2017.
Office
Use
only
Date received Time received Initials
3e
NI Assembly Election
Appointment of postal vote agents
Constituency
Date of election
Thursday
2 March 2017
Postal vote agents can be appointed by the candidate or their election agent.
The Deputy Returning Officer will tell you the maximum number of postal vote agents you can appoint
and the place/date/time for the issue/opening of postal votes.
Postal vote agents must produce photographic identification of a type that can be used by a voter to gain
access to the issue/opening.
Incomplete, illegible or incorrectly completed forms will be invalid.
Candidate’s name
Election agent’s name
Candidate or election agent’s
signature
I appoint the following people as postal vote agents for the above constituency:
Full name (CAPITAL LETTERS)
Full address including postcode (CAPITAL LETTERS)
This form must be delivered to the Deputy Returning Officer before the time fixed for the
issue/opening.
Office
Use
only
Date received Time received Initials
4
NI Assembly Election
Electoral Register/AV list request
Constituency
Date of election
Thursday
2 March 2017
Warning: Please note the restrictions on use of the register and of the information contained
in it set out in Part 6 of the Representation of the People (Northern Ireland) Regulations 2008.
Contravention of these provisions is a criminal offence upon conviction for which the
offender would be liable to a fine not exceeding £5,000. Any person who obtains a copy of
the register and does not complete the nomination process must return the register or the
matter will be referred to the police.
This form must be completed by the candidate and submitted to the Deputy Returning Officer.
Candidate’s name
I declare that I am a candidate at the above named election. I will use my copy of the electoral
register/absent voter list for electoral purposes and checking the validity of donations only.
I will only allow others who are assisting me in my campaign to use my copy of the electoral
register/absent voter list for the same purposes. My request is for the latest version of the register
and any revisions or notices of amendment while I am a candidate. In the event that I do not
complete the nomination process I undertake to return the registers/absent voters list and notices
of amendment. I understand that if I do not return these documents the matter will be referred to
the police.
Candidate’s signature
My application is for the electoral register in (tick one box only)
Paper format
Data format
Absent voter list required
Yes
No
Overseas register required
Yes
No
Candidate’s address
(in full)
Phone no.
Email address